Norwich Medical School, University of East Anglia, Norwich, UK.
Expert Rev Mol Diagn. 2015 May;15(5):681-92. doi: 10.1586/14737159.2015.1029459. Epub 2015 Apr 12.
Bloodstream infection (BSI) by microorganisms can lead to sepsis. This condition has a high mortality rate, which rises significantly with delays in initiation of appropriate antimicrobial treatment. Current culture methods for diagnosing BSI have long turnaround times and poor clinical sensitivity. While clinicians wait for culture diagnosis, patients are treated empirically, which can result in inappropriate treatment, undesirable side effects and contribute to drug resistance development. Molecular diagnostics assays that target pathogen DNA can identify pathogens and resistance markers within hours. Early diagnosis improves antibiotic stewardship and is associated with favorable clinical outcomes. Nonetheless, limitations of current molecular diagnostic methods are substantial. This article reviews recent commercially available molecular methods that use pathogen DNA to diagnose BSI, either by testing positive blood cultures or directly testing patient blood. We critically assess these tests and their application in clinical microbiology. A view of future directions in BSI diagnosis is also provided.
血流感染（BSI）由微生物引起，可能导致败血症。这种病症的死亡率很高，如果不及时开始适当的抗菌治疗，死亡率会显著上升。目前用于诊断 BSI 的培养方法检测时间长，临床灵敏度差。在临床医生等待培养诊断的同时，患者接受经验性治疗，这可能导致治疗不当、产生不良副作用，并导致耐药性的发展。针对病原体 DNA 的分子诊断检测方法可以在数小时内识别病原体和耐药标记物。早期诊断可改善抗生素管理，与良好的临床结果相关。尽管如此，目前分子诊断方法仍存在诸多局限性。本文综述了最近商业化的基于病原体 DNA 的分子方法，这些方法通过检测阳性血培养物或直接检测患者血液来诊断 BSI。我们对这些检测方法及其在临床微生物学中的应用进行了批判性评估。还提供了对 BSI 诊断未来发展方向的看法。
